Assessing Sedation Depth with PSI in Elderly ERCP Patients: A Prospective Cohort Study

• Published in: Clinical interventions in aging 2025, Vol.20, p.137-145
• Main Authors: Huang, Lei, Liu, Lin-Lin, Lu, Yong-da, Zhuang, Min-Yuan, Dou, Wei, Liu, Hong, Ji, Fu-Hai, Peng, Ke
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Airway management; Anesthesia; Anesthesia Recovery Period; Blood pressure; Body mass index; Cardiovascular disease; Cholangiopancreatography, Endoscopic Retrograde; Cohort analysis; Conscious Sedation - methods; Consciousness Monitors; Correlation analysis; depth of sedation; elderly patients; Electroencephalography; endoscopic retrograde cholangiopancreatography; Endoscopy; Female; Heart rate; Humans; Hypnotics and Sedatives - administration & dosage; Hypotension; Hypoxemia; Male; modified observer’s assessment of alertness/sedation; Nausea; Original Research; patient state index; Patients; Propofol - administration & dosage; Prospective Studies; Software
• ISSN: 1178-1998; 1176-9092; 1178-1998
• DOI: 10.2147/CIA.S504212

Adequate sedation is important for elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Patient state index (PSI) via the SedLine® system has been utilized for real-time monitoring of anesthesia depth in surgical patients. We aimed to assess the correlation between PSI and Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scores in elderly patients undergoing ERCP. This prospective cohort study included 57 elderly patients scheduled for ERCP procedures. Patients received target-controlled infusion of propofol, titrated to the sedation level of MOAA/S scores of 1 and 2. The MOAA/S scores and PSI values were recorded during sedation and recovery. We also documented procedure and recovery time, oversedation (PSI < 25 for at least 10 min and EEG burst suppression), adverse events, and fatigue scores (0-10, higher scores indicating more fatigue). All patients completed this study (mean age of 73 years and 63% male), with a mean procedure time of 53 min and recovery time of 37 min. Five patients (8.8%) experienced PSI < 25 for at least 10 min, and three of them (5.3%) showed EEG burst suppression. No patients developed desaturation or intra-procedural awareness. Hypotension and abdominal pain were uncommon. Nine patients (15.8%) experienced mild dizziness or nausea. The median (IQR) fatigue score was 3 (2-4) at recovery room discharge. A significant correlation was observed between the MOAA/S scores and PSI values (Spearman correlation coefficient = 0.742, < 0.001). When patients were at the MOAA/S scores of 1 and 2, the median PSI was 50 (95% CI: 48 to 52). PSI provides a useful and real-time monitoring of sedation for elderly patients undergoing ERCP. Our results showed a significant correlation between the PSI values and MOAA/S scores and suggested a PSI value of 50 with a range of 48 to 52 for maintaining adequate sedation. Chinese Clinical Trial Registry (ChiCTR2400079859).